| NPI | 1992152276 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEODORE E WALLS Owner 413-345-8745 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: VT 068.0067951) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: VT 089.0000688) |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2016-09-29 |